HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I
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Permit Number: v-y
Building Permit Application NOV 2 7 2017
Planning and Development Services
Building and Code Regulation Division PERP1I17ING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Z4� Vk '
PROPOSED IMPROVEMENT LOCATION:
Address: '6 �
Legal Description: , fi 424
Property Tax ID#: `f l0—.SO)— 3 S"Q -- d,0d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: �Wz1 te' �O
, e lfoo At ei eeazi e
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CONSTRUCTION IN ORMA ION:
ACIditiona work e e orme un er this perms —c ec a appy:
HVAC Gas Tank ❑Gas Piping Shutters (�Windows Doors
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Electric Plumbing Sprinklers E]Generator ZRoof Roof pitch
Total Sq. Ft of Construction: U Sq. Ft.of First Floor:
Cost of Construction:$ j aU Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name1 �� Name: e^ 2ttC
Address: i// Company: 11t�' EC -;
City: Stater Address: Z
Zip Code: 0- Fax City: /Fy. State:
Phone No. ��, 3 — -. �7�� Zip Code: Fax:�7L- l
�� �t 82-
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:_ 5;—y?�r �i 0N!/t�lLe
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencingowork or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 1 .C1
COUNTY OF— 1JJC,1�, COUNTY OF U.J
The for ng instrume t w acknowledged efore me The f r ing instru w s acknowledged fore me
this day of 20by thisday of 20� by
be>A law R16.
Name of person making statement / Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification J.//
Type of Identific ' n Type of Identification
Produced L Produced
i
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
KAREN S. gkl�t SEN
Commission No. N S. NIELSEN Immission N 'X., °-'• ission# 637
:
Commission# FF 115637 . +:
.- fires a, My Commission Expires
My Commission Exp o...^'.`� June 12, 2018
eZ:
REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17